Strategy for extubation of the difficult airway: a protocol and table of air way devices Francisca Llobell, MD 1 , Patricia Marzal, MD1, Marisol Echeverri, MD1, Lauren Hoke, BS and Yvon Bryan, MD 2 Intubation algorithms for patients with difficult airways (DA) and guidelines for extubation in critical care units existStandards for extubation of patients with DA’s are vague despite risk of complications Protocol and table of devices during extubations enhanced patientsafety in patients with DA’s Availability of devices at extubation prepares one for differentairway scenarios 1 Hospital G. U. Mari na Alta, Denia (Alicante), Spai n - 2Wake Forest University Baptist Medical Center, Winston-Salem, NC, USBackground & Goals of Study Table for extubation of DA divided into 4 quadrants according to function (Figure 1) Four quadrants are (clockwise from upper left): 1. Oral, nasal airways, LMA’s to improve oxygenation and ventilation 2. Airway exchange catheters, stylets, guidewires to delay extubation or re- intubate 3. FFB and Bonfils to visualize glottis 4. Cricothyrotomy kit and TTJV for surgical access Methods Results Discussion Figure 1 Table 1 75 60 70 68 M F M M Prostate cancer Acute abdomen Dysphonia Vocal cord nodule Radical Prostatectomy Exploratory Laparotomy Microsuspension Laryngoscopy Microsuspension Laryngoscopy Airtraq FFB nasal FFB oral Airtraq Proseal LMA CAEC CAEC CAEC 1 2 3 4 72 68 65 75 Age (yrs) Weight (kg) Sex Diagnosis Surgery Intubation devices Extubation devices Case ID Further research is required in creating extubation protocols in pa- tients with DA Background and Goals of Study Intubation algorithms for patients with difficult airways (DA) and extubation guidelines in ICU patients exist (1). Extubation of patients with difficult airways is less standardized despi- te many complications reported after extubation (2, 3). We created an extubation protocol in patients with a known difficult airway consisting of an airway device table used to bridge extubation. We present our experience with this protocol and table for extubating patients with d ifficult airways. Methods We created a table for extubation of the difficult airway divided into 4 quadrants according STRATEGY FOR EXTUBATION OF THE DIFFICULT AIRWAY: A PROTOCOL AND TABLE OF AIRWAY DEVICES Abstract Results We used the algorithm and table for extubation in 4 patients (see Table 1). No patients ex- perienced any complications and the mean time to extubation was 58 (range of 30, 90) mi- nutes. Discussion The protocol and table during extubations enhanced the safety in patients with difficultairways. The availability of devices at extubation prepares one for different airway scena- rios. Further research is required regarding extubation protocols in patients with difficultairways. Hospital Universitario Marina Alta We created extubation protocol in patients with known DA consis- ting of device table used to bridge the extubation
